Non-Urgent Health Office Request                    READ before completing 

DO NOT EXPECT AN IMMEDIATE RESPONSE.
DO NOT USE THIS OUTSIDE OF CLASS TIME. There is no way I can find you during non class times.


Do not use this for emergencies.
A call slip will be sent in the order in which requests were made.


YOU ARE WELCOME TO STOP BY BEFORE SCHOOL, PASSING, BREAK OR LUNCH without a request.


5th period: Only emergent medical needs will be addressed. Teacher will call office/main office for emergencies.


Acetaminophen (Tylenol) and ibuprofen (Advil/Motrin) only administered with a parent consent on file.


Items NOT available:
- allergy medication                       - super glue
- cough drops                                 - extra clothing
- cold/cough medication              - Midol, Aleve or Pepto
- food                                               - Any type of diagnosis


A call slip will be sent for you when there is availability in the health office. If you have an immediate medical concern (for example - bloody nose, concussion, bone break, diabetes concern, passing out etc.) please ask your teacher to call the nurse's office for more immediate assistance.

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Email *
First Name *
Student Last Name *
Visit request reason, check all that apply *
Required
Please give a brief description of your concerns or need to see the school nurse. *
Visit Goal *
Any other information the nurse needs to know (ex: I hit my head over the weekend, sore from working out, I had a fever yesterday, etc) *
Have you already contacted your parent or guardian about this issue? *
Submit
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